(Following from\Swinging on the Hammock) Okay, watch the video. I’ve highlighted the moment that jumps out for me.
RYAN: It’s a sign of the times, I think. I think it’s a sign of anxiety of the times. It’s also a sign of the misinformation that’s been perpetrated out there.
AMANPOUR (on-screen): Well, why do you say “misinformation”?
RYAN: Well, there are TV, radio and phone calls that are running, trying to scare seniors. You know, the Democratic National Committee is running phone calls to seniors in my district, TV ads, saying we’re hurting current seniors when, in fact, that’s not the case. And so there’s a lot of…
AMANPOUR: Isn’t that, though, par for the course?
AMANPOUR: I mean, didn’t you lot do it the last time?
RYAN: Yes, Republicans — Republicans — both parties do this to each other. And my whole point about that is, that’s why we have this political paralysis.
Let’s entertain a thought problem. Scroll ahead to a perfect Tea Party storm in the 2012 election, after which the Ryan health care overhaul becomes a reality. Shortly afterward we’d know for sure which seniors are getting hurt. I assuming the meaning of ‘hurt’ is that the cost of health care for those over 65 undergoes a non-trivial increase. In anticipation of this, since all we have is the letter of the current plan, whether it hurts current seniors–say, those born before 1947–is answerable in the exacting terms articulated in this current plan.
Without parsing the exact position on this found in the plan, it’s interesting to suppose this perfect electoral storm happens, and, shortly afterward, passing and implementation of, for the sake of argument, Ryan’s current plan. Obviously, a year later we would have the painless ‘old system’ co-existing with a few or all elements of the privatization scheme, for those too young to be grandfathered into ‘regular Medicare.’ How this would work is an unspecified group of adults shy of 65 right now would be allowed to enroll in Medicare when he or she reaches 65. The most talked-about cutoff for current adults is 55. What I will term, Medicare II, the voucher-driven and privatized Ryan plan, kicks in 2022.
Of course we know that ‘hurt’ as previously defined is the truth about the privatized scheme. It would seem politically untenable to have a dual system play out over forty to fifty years–until all the ‘Medicare’ seniors die off. However, the point of my thought problem is this: the assertion that Medicare seniors would not be subjected to ‘hurt’ is entirely contingent on there being zero changes to the current Medicare provision. So, to falsify the assertion all one has to do is go into the Ryan plan and see if it is, in effect, a zero change (to Medicare) plan for this select group of seniors.
There really isn’t a Ryan Plan. Take a look yourself, it’s a wish list. I suspect what would happen is that Medicare I. would be substantially altered to bring it down toward the benefits and objectives (“socialize risk/privatize profits”) of Ryan’s actual concrete, Medicare II. plan. He’s got a rhetorical agenda: to convince adults over the age of 55 (in 2011 or 2012) that they will enjoy the level of coverage, low premiums, and unpredictable pharmaceutical co-pays (Medicare D,) of Medicare I. while moving to abolish it for everybody else– Medicare II. I’m suggesting there is zero chance implementation of a actual Ryan Plan would leave Medicare I. unscathed for the 55-and-older crowd. It’s the other shoe–to be dropped.
From page 46, The Path to Prosperity, Fiscal Year 2012 Budget Resolution, (where the Ryan, health care plan is sketched out.)
These reforms also ensure affordability by fixing the currently broken subsidy system and letting market competition work as a real check on widespread waste and skyrocketing health-care costs. Putting patients in charge of how their health care dollars are spent will force providers to compete against each other on price and quality.
That’s how markets work: The customer is the ultimate guarantor of value.
Market competition hasn’t delivered any check on waste and costs in the segment of the market that is totally privatized, non-Medicaid and non-Medicare insurance. One reason is: markets do not work the way Ryan states that they do.
Ryan here makes a criticism about a gang of thirteen deciding health care benefits. However, his own proposal replicates what we have now, which is an army of thousands of ‘deciders’, and each serves masters whose proprietary objective is to make money.
There many similar rhetorical appeals made on behalf of privatization-centered reform, with the most astonishing being at the end of this paragraph from The Heritage Foundation.
One of the key advantages of Ryan’s proposal for competition among plans and providers is that it would, as Orszag concedes, surely encourage Medicare beneficiaries to seek the best value for dollars in meeting their health care needs. If seniors enrolled in health plans which were less expensive than their Medicare contribution, they could apply the remainder to their medical savings accounts and secure their savings. If they instead chose to enroll in a more generous plan, with premiums higher than Medicare’s contribution, they would pay the difference. This approach to financing is fair and equitable.
With this, we land fully in the kingdom of ideology. Let’s add the other important revolutionary component: end of employer-provided group health insurance. Then, everybody’s on their own, with huge ranges of choices between affordable policies and unaffordable policies. Of course it’s possible the choice in 2022 for a diabetic sixty-five year old with a bum knee, with household income of $50,000, might be severely limited to a handful of catastrophic coverage plans. Such a plan would cover the amputations. Yet, begged here is what would the Federal policy with respect to paying for procedures above and beyond what their low-end policy provides for? Ryan’s current answer is less than vague.
What would be the practical scenarios for paying for the needs of the population that can only under insure themselves? (For this population, the choices would be made among exactly the kinds of insurance which don’t pose any cost pressure at all!)
I almost always go searching for contextual features presumably available in the background of systematic ideological positions. So I look for clear statements of the ideological ideas. Mr. Ryan supplies this context in Health Care Reform and the American Character, By Congressman Paul Ryan, American Spectator, July 2009.
It provides an amazing wash of cryptolectic ideology . That it presents its context-free historical interpretation as patriotic catechism is garden-variety (and tiresome) polemic. Here’s a paragraph that is impressive for its shameless display of what would seem to be comprehensive ignorance.
How are health care and American character linked?
Public health has always been a government priority. The unquestioned power to quarantine for contagious sicknesses in order to protect the community’s health has been used for centuries. Selling unwholesome food and drink, carrying on industrial trades that infect or pollute the air, as well as neglect, unskillful management, and experimentation by doctors and pharmacists have traditionally been treated as crimes and grounds for civil lawsuits. Immunization programs to protect populations against disease have long been accepted as a legitimate government service.
What is it about: the health of, history of the health of Americans, and, the history of healthcare, from the time of the founders to now? This would be an actual subject of study or inquiry. I would expect the history of health and healthcare in America to be very complicated, possess a lot of moving parts, and be to a greater extent than lesser, embedded in particulars of culture and era. Is this accurately summed by this very odd summation offered by Ryan? In the main, his enumeration of interventions and public interest does not support his assertion: Public health has always been a government priority.
The facts of the matter are obviously different. Health insurance is not a long-standing free market offering. It has a history, as a form of enterprise and as a form of risk management. The history of dangerous-to-health human practices itself has a long history. We could, if we wanted to, develop the two tracks of the history of public interest in health, and, the private disinterest in health. I figure it took about 150 years for the private sector to begin to develop an interest in the health of its workers and customers. We have far fewer nine and eight fingered workers today.
Nowadays we live long enough to die of maladies that in the 19th century we didn’t live long enough to come down with in the first place. The workplace is much safer in 2011 than it was in 1950, 1900, 1850, 1800. There also is a huge historical literature containing the observations of doctors about American health. All of this is lost on Ryan. Why? Because the historical facts ruin his argument.
He goes on, and in the next paragraph writes,
In other words, the priority of protecting people’s health, which is implicit in our founding principles, no more requires government to provide health care programs than, say, the legitimate concern that people be housed requires the government to build public housing. Government has a duty to secure these rights, but this obligation is normally met most effectively by establishing the legal and economic conditions for free markets that expand the opportunity and prosperity of all.
This last assertion is instantly falsifiable by considering the history of American health. Americans have already lived during an era of, largely, unfettered free markets, when government was little involved in protecting the health of its citizens. I always chuckle; because America has already passed through the free market paradise. It has been tagged with a good name too: the era of the Robber Barons.
Ryan first enumerates a minimalist governmental interest in health, and, next posits private interests would work hand in hand with the consumer to reach the win/win of risk management-plus-value. So, the government should have little to say or do about health–exceptions noted–and we should return to the free market ‘that which normally most effectively accomplished’ basically nothing on its own with respect to the health of the citizenry.
Consider the fifties and sixties. What wholly private sector health initiatives would you point to, which would demonstrate a ‘normal effectiveness’ came to be implemented with respect to protecting the health of Americans? I am impressed with Ryan’s ignorance given the furthering context of his chutzpah. Why? Because it is today a point of doctrine that we’d benefit ‘healthwise’ from the dismantling of the employer-provided group insurance system! Geez, American industry was dragged kicking and screaming into that system, and it would be better to turn it all over to the free market?
The (Ayn) Randian flavor comes to the fore in the two-and-a-half pages that ensue; although Toqueville gets to stand in.
As Tocqueville discerned in Democracy In America, a human being who fails to practice these fundamental habits, especially the key virtue of practical wisdom, will gradually lose the ability to sustain basic human qualities and sentiments. Lacking the habit of making prudent decisions every day about one’s well-being and learning to accept the consequences of those decisions, one becomes a victim of necessity, passively serving unaccountable rulers who take it on themselves to define and satisfy the victims’ needs, desires, and pleasures.
Toqueville’s sentiments were sensible in their quaint early 19th century context, but of course they are ridiculous today. It’s not surprising that he had no ability to appreciate social complexity and sociological dependencies, interactive social processes, and gradients of agency. Etc. And so, why not deploy anachronistic Ayn Rand, the last of the 19th century, (And similarly,) hydraulic idealists? Why not, then, term every last unemployed person to be lazy, and suffering from grievous deficits of personal responsibility and self-reliance and, umm, practical wisdom?
Moralistic false dichotomies rule the ideologically infected discussion today. I can think of two revealing contextual aspects. First, having more money than you know what to do with usually insulates one from many consequences of morally hazardous behavior. For example, the major financial domos who lost their jobs because they were so effective at ruining their bank’s bottom lines, nevertheless, walked away with, in most cases, at least tens of millions of dollars. There was no major sanction delivered on the other side of their lapse in personal responsibility. (Secondly;) however, the sanctions delivered to millions of Americans for the single reason that their (now disappeared jobs) were interconnected with the credit squeeze, are, now, part of the plan to remind them to be even more “personally responsible.”
Health. Ryan’s solution? Catastrophic insurance and the emergency room and the altruism of the free market., with a nifty pass through of tax revenues right down to the insurer’s bottom line.